A Literature Review by BCIS R&D Group
There are varying PCI techniques for unprotected distal left main (ULM) disease including single stent strategy, provisional T-stenting (PS), crush technique, or culotte. No trial had previously compared DK crush with PS in the context of ULM disease. The DKCRUSH-V randomized trial was a prospective, randomised, international, multicentre study of 482 patients with distal ULM disease scheduled to undergo PCI to evaluate the comparative outcomes of DK crush with PS. The main inclusion criteria were silent ischemia, stable or unstable angina, MI>24 hours before treatment, distal left lesion (Medina 1,1,1 or 0,1,1) with >50% stenosis of both the ostial Cx and LAD by visual assessment.
The primary end point was target lesion failure defined as the composite of cardiac death, target vessel MI, or clinically driven target lesion revascularization at 1 year follow-up. Secondary end point included all cause death, all MI, periprocedural troponin I release, clinically driven revascularization, angina, and in-stent restenosis. In this study, DK crush was associated with a significantly lower primary end point (5% vs. 10.7%; p=0.02). DK crush was also associated with lower rates of target vessel MI (0.4% vs. 2.9%; p=0.03). Clinically driven target vessel revascularization (3.8% vs. 7.9%; p=0.06) and angiographic restenosis (7.1% vs. 14.6%; p=0.1) were numerically lower with DK crush.
In this randomised trial, DK CRUSH was associated with a superior outcome compared to PS in LM PCI.